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Anchorage is defined as ³resistance to unwanted tooth movement´. It is the resistance to reaction forces that is provided
(usually) by other teeth, (sometimes) by the palate, head or neck(via extra oral force) and(less frequently ) anchors screwed to the jaws.
An important aspect of treatment is maximizing the tooth movement that is desired, while minimizing undesirable side effects.
Tooth movement Optimal force Pressure 4 .
5 . Forces greater than that would be unnecessarily traumatic and unnecessarily stressful to anchorage.` ` The optimum force level for orthodontic tooth movement is the lightest force and resulting pressure that produces a near maximum response.
` ` Intramaxillary anchorage Intermaxillary anchorage 6 .
If a removable appliance is used. 7 .` ` ` Depends on the size of teeth i. the base plate and retaining cribs should contact as many of the teeth as possible as illustrated below.e. the root area. The more teeth that are incorporated into an anchorage block the less unlikely unwanted tooth movement will occur.
9 . cribs on the first permanent molars and upper incisors will not only help in retention but also increase the anchorage considerably.` If upper canines are to be retracted with a removable appliance.
` ` ` Teeth in the opposite arch can provide very useful and important sites of anchorage control as illustrated below. Good interdigitation of the buccal teeth can help prevent mesial movement of the buccal segment. 11 . The second way is by means of elastics.
Contact between an orthodontic appliance and the vault of the palate provides resistance to mesial movement of the posterior teeth. Therefore the higher the vault the greater the buttressing effect.` ` ` Contact between the appliance and the labial or lingual mucosa can increase anchorage considerably for either fixed or removable appliance. 15 .
for example a Nance palatal arch that incorporates an acrylic button.` ` The mucosa can also be used when fixed appliances are used. These are of limited use if the palatal vault is shallow. 16 .
They do not move when a force is applied to them as they do not have a periodontal membrane.` ` ` Osseo-integrated implants can be used as a very secure source of anchorage. Small implants for orthodontic use have been specifically designed recently. 18 .
` ` ` ` ` Reciprocal tooth movement Reinforced anchorage Stationary anchorage Cortical anchorage Skeletal(absolute) anchorage 19 .
and so is the force distribution in the PDL. A simple example is what would occur if two maxillary central incisors separated by a diastema were connected by an active spring. the forces applied to teeth and to arch segments are equal.` ` In a reciprocal situation. 20 .
` ` A similar situation: a spring placed across a first premolar extraction site. lateral incisor and canine in the anterior arch segment against the second premolar and first molar posteriorly. pitting the central incisor. 21 . ³Anchorage value´ roughly equivalent to its root surface area.
25 . the anchorage of the posterior teeth would be reinforced by adding the second molar to the posterior unit.` Given the above extraction site example: if it was desired to differentially retract the anterior teeth.
burned or blown the anchorage by moving the anchor teeth too much. Thus reducing the pressure on the anchor units. Too much force destroys the effectiveness of reinforced anchorage. 26 .` ` ` ` This results in the reaction force being distributed over a larger PDL area. The clinician is said to have slipped.
if the appliance were arranged so that the anterior teeth could tip lingually while the posterior teeth could move bodily. Using our same example of a premolar extraction site. 28 . the optimum pressure for the anterior segment would be produced by about half as much force as if the anterior teeth were to be retracted bodily.` ` It refers to the advantage that can be obtained by pitting bodily movement of one group of teeth against tipping of another.
Successful implementation of this strategy requires light force. 29 .` ` This would mean that the reaction force distributed over the posterior teeth would be would be reduced by half. and as a consequence move half as much.
31 . Cortical bone is more resistant to resorption. and tooth movement is slowed when a root contacts it.` ` Another consideration in anchorage control is the different response of cortical compared to medullary bone.
extra-oral force(headgear) was the only way to obtain anchorage that was not from the teeth. 32 .` Until recently.
` ` ` With the development of successful bone implant techniques. 45 . bone anchors placed beneath the soft issue. with no tooth movement except what was desired. the potential existed for what could be described as absolute anchorage. usually in the zygomatic buttress area of the maxilla. The principal options include titanium screws that penetrate through the gingiva into alveolar bone Secondly.
And to create the bone remodeling needed for tooth movement. force is needed for two purposes: to overcome frictional resistance. 55 .` When teeth slide along an arch wire.
by how much. 56 .` Several potential strategies can be used to control anchorage and all are affected by whether friction will be encountered and if so.
4 to 1 with it. For significant differential tooth movement.` ` ` The extent to which anchorage should be reinforced(by adding teeth to the anchorage unit) depends on the tooth movement that is desired. This involves including as many teeth as possible in the anchorage. 57 . the ratio of PDL area in the anchorage unit to PDL area in the tooth movement unit should be at least 2 to 1 without friction.
it would be perfectly possible to reduce the strain on posterior anchorage by retracting the canine individually. pitting its distal movement against mesial movement of all other teeth within the arch. 58 .` ` A common way to improve anchorage control is to pit the resistance of a group of teeth against the movement of a single tooth. In our extraction site example.
59 . Forces must be kept as light as possible so that the teeth in the posterior segment are always below the optimum force range while the anterior teeth receive optimum force.` ` Another possible strategy for anchorage control is to tip the teeth and then upright them. rather than moving them bodily.
Appliance philosophy: the approach to anchorage control that is implicit in the appliance design. 60 . indeed are literally built into the appliance in many instances.` ` Strategies for anchorage control are associated with particular orthodontic appliances.
61 . that was very difficult or impossible previously. especially in adults.` ` Devices used for temporary skeletal anchorage are referred to as temporary anchorage devices(TADs). This approach makes it possible to move to accomplish tooth movement.
G. 196: 255-263. Sandy J. Fourth edition. Am J Orthod Dentofacial Orthop 2008. Miniimplant Anchorage For The Orthodontic Practitioner. British Dental Journal 2004.` ` ` Proffit W.R. Part 9: Anchorage Control And Distal Movement. Baumgaertel S. Roberts-Harry D. Contemporary Orthodontics. Orthodontics.R.Razavi M. Elsevier 2008. 62 . Hans M.133:621-7.